Individual
DR. MARVIN PRESTON EADY JR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4646 W JEFFERSON BLVD, SUITE 140, FORT WAYNE, IN 46804-6842
(260) 459-1415
(260) 459-1419
Mailing address
4646 W JEFFERSON BLVD, SUITE 140, FORT WAYNE, IN 46804-6842
(260) 459-1415
(260) 459-1419
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12009115A
IN
Other
Enumeration date
01/18/2006
Last updated
07/09/2007
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